Pharmacy Recovery Analyst - Payer to Payer

Who We Are

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: Option 1: This position will be hybrid, with opportunity to work full remote after training as well as in our La Grange, KY office.

About the Opportunity

At Machinify, we're constantly reimagining what's possible in our industry-creating disruptively simple, powerfully clear ways to maximize our clients' financial outcomes today and drive down healthcare costs tomorrow. As part of the Pharmacy Payer-to-Payer team, you will work to recover overpayments from healthcare providers and employer groups. You will communicate persuasively with providers to facilitate refunds. This communication takes place primarily through inbound and outbound calls to providers and insurers. The Recovery Analyst will also handle other administrative duties to remain current on their accounts.

What you'll do

• Contacts healthcare providers and employer groups to explain coordination of benefits on behalf of Rawlings' clients.
• Coordinates claims billing to the insurance carrier and assist in responding to appeals and/or claim denials
• Coordinates the provider refunds in accordance with training guidelines.
• Maintains detailed records regarding all activities and communication on patient accounts.
• Effectively determines when to escalate recovery issues to a higher level.
• Effectively communicates issues and concerns with peers and leadership.
• Actively seeks to identify process improvements to increase workflow efficiency.
• Understands Medicare and Commercial primacy rules.

What experience you bring (Role Requirements)

• Excellent oral and written communication skills are required, including a significant amount of provider/physician contact on the phone.
• Customer service experience highly preferred.
• Ability to work independently or in a team environment.
• Very strong attention to detail and organizational skills.
• Word and Excel proficiency is preferred.
• Experience in the healthcare field is helpful, but not required.

What Success Looks Like...

After 3 months

You will have a strong understanding of the role.

You begin building relationships and collaborating with peers.

You develop effective time and priorities management.

You receive initial feedback about your performance and are using it to improve.

You've gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.

You have established a strong network of internal relationships and are recognized as a key collaborator.

You've been entrusted with greater responsibility indicating the company's confidence in your abilities.

You see opportunities for career progression and personal development.

Pay range: $47,000 with bonus opportunity. This is an exempt position. The salary range is for Base Salary.

What's in it for you

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

At Machinify, we're reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative, accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we're passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer.

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